Spooked by Illinois' budget standoff, some med school grads are hitting the road for their post-university training rather than risk their educations and careers.

No one would expect Matt Soltys to leave Illinois, given his family's century of residency. Raised near Springfield, the 27-year-old grew up cheering for the Illini. He earned dual molecular biology and kinesiology degrees from the University of Illinois at Urbana- Champaign before heading to Southern Illinois University's School of Medicine, where his parents, both Illinois natives, also earned degrees. Soltys lived with his 95-year-old grandfather, another Land of Lincoln lifer, as he pursued his medical degree. His girlfriend, a third-year SIU med student, hails from Peoria.

But on June 3, Soltys will drive 225 miles northwest to start his internal medicine residency at the University of Iowa in Iowa City.

"It's fully hitting me that I'm leaving, and I'm really sad," he says—but not sad enough to risk the quality of his medical education by staying in a state whose government is in trench warfare with itself. "The thought that the budget impasse might affect my medical education and my patients is incredibly frustrating. I wanted to go to an institution that didn't have those constraints."

New graduates of the state's two publicly funded medical schools are hightailing it to other locales for their post-university training. Though school leaders offer differing opinions on whether these grads are spooked by the state's interminable standoff or leaving for other reasons, the underlying fact is clear: The number of medical graduates from SIU and the University of Illinois College of Medicine who will remain in Illinois for their residencies has hit a combined all-time low.

Soltys has had a rare vantage point into the effects of the budget fight. His father, Stephen Soltys, ran the psychiatry department of SIU's medical school until last year. When he began working at SIU in 2002, the department had six faculty positions funded by the state. Now there are none. Matt Soltys​ periodically gets emails from Jerry Kruse, dean of SIU's School of Medicine, discussing the impact of the budget standoff on the school. He also has watched with concern as two community hospitals in Springfield cut their funding for internal resident positions.

Photo

Terry Farmer

SIU med school grad Matt Soltys will do his internal medicine residency at the University of Iowa.

"As I was trying to make my decision," Soltys says, "I kept thinking: For the past two years, all I've been hearing is that the state doesn't have a budget." He adds: "The worst thing as a medical provider is knowing what resources you need to help a patient but not having them."

According to Kruse, the percentage of his school's grads who choose to complete residencies in Illinois has plummeted to 21 percent this year—the lowest in school history. The share has decreased 9 percentage points each year since 2014. For decades before that, the percentage of SIU's roughly 70 annual med school graduates who stayed always hovered between 40 and 45 percent.

Meanwhile, across the four campuses of U of I's College of Medicine, which include its flagship on Chicago's West Side, just 28 percent of this year's graduates are staying in Illinois for their residencies. That's down from nearly 37 percent last year.

Dimitri Azar, the school's dean, isn't ready to say that it's more than a blip. U of I's trend line hasn't gone straight down, as SIU's has. The percentage of U of I grads who remained in Illinois for their training was 33 in 2015, 41 in 2014 and nearly 34 in 2013. Furthermore, Azar says, students choose their destinations primarily based on the quality of the program, not the quality of the state's finances.

Kruse, however, ties the exodus directly to the budget fight between Gov. Bruce Rauner and Democrats who control the General Assembly. "Nothing has changed much over this period except the budget impasse and the atmosphere it's created," Kruse says. "Young doctors read about it in the papers every day and suddenly there's a fair amount of uncertainty about the future." Illinois has not had a permanent budget since January 2015.

Regardless, private medical schools in the area—which don't rely on state funding—aren't seeing the same declines. At Loyola University's Stritch School of Medicine, the share of 2017 grads staying in Illinois is 39 percent; it was 40 percent last year and 39 percent in 2015. And at Northwestern's Feinberg School of Medicine, the percentage of new grads who will complete residencies in Illinois reached a five-year high of 44 percent this year.

OTHER INCOME

Illinois' public medical schools are slightly buffered from the state's budget crisis because they also generate income from patients treated by doctors affiliated with the universities' health systems. SIU Medicine, for example, earns more than $90 million annually and helps subsidize the medical school's $189 million operating budget. Still, "the clinical practices do not have big margins to help the medical school," Kruse says, and they certainly don't make up for the $19 million shortfall in annual state funding to the med school.

It doesn't help that a lot of SIU Medicine's patients around Springfield are state employees. Though government workers continue to pay their insurance premiums, Illinois has not paid an estimated $3.5 billion in medical bills for its employees and retirees. Today an average SIU Medicine bill for a state employee sits in accounts receivable for 400 days, and altogether, Kruse says, his institution is owed close to $10 million by the state for patient services.

As a result, the medical school instituted a permanent 12 percent cut in the amount it budgets for state allocations—equal to about a $7 million decrease—and also lowered doctors' clinical pay by 5 percent. Kruse also asked faculty to find more grants. All of this has led to rumors among his students that residency programs in Illinois will start closing their doors and cutting class sizes. "Nothing could be further from the truth," Kruse says, "but the students are worried after so much bad news."

Research shows that doctors tend to settle wherever they complete their residency. That's because by then, most are in their early 30s and may have married during their training; they also will have spent several years establishing working relationships in that city's health systems. So every med school graduate who decamps for training marks a painful loss, particularly as the need for primary care physicians is predicted to increase. "Each person represents 30 years of doctoring time," Kruse says. "It might have an impact on Illinois for decades."

Soltys says he's not sure where he'll practice medicine after he finishes his training, but he acknowledges that moving back home would require more effort. "I want to do academic medicine, and I could see myself working at the University of Iowa because I'll already know the system," he says.